Provider Demographics
NPI:1801994371
Name:MAURY, DORIS R (DMD)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:R
Last Name:MAURY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 CALLE W BOSCH APT 1209
Mailing Address - Street 2:TERRASAS DE SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4669
Mailing Address - Country:US
Mailing Address - Phone:787-282-7492
Mailing Address - Fax:787-282-0711
Practice Address - Street 1:502 CALLE LUIS MUNIZ SOUFFRONT
Practice Address - Street 2:VILLA GRANADA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-2419
Practice Address - Country:US
Practice Address - Phone:787-282-7492
Practice Address - Fax:787-282-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2247OtherDENTIST LICENSE P.R.